Anxiety Disorders in Children

Anxiety Disorders in Children

• Approximately 10-15% of children experience an anxiety disorder during childhood.
• A defining characteristic of anxiety disorders is a persistent state of fear or worry that significantly impairs a child's normal functioning, disproportionate to the situation.

Etiology of Anxiety Disorders

• The etiology of anxiety disorders has a genetic basis, significantly influenced by psychosocial experiences.
• Heritability is polygenic, with only a limited number of specific genes identified.
• Anxious parents often have anxious children, potentially exacerbating the child's challenges.
• In 30% of cases, treating parental anxiety alongside the child's can be beneficial.

Symptoms, Signs, and Diagnosis

• The most common presentation is school refusal ("school phobia").
• Some children explicitly express their worries (e.g., "I'm worried I won't see you again").
• Many children express their distress through somatic complaints (e.g., stomachaches).

Generalized Anxiety Disorder (GAD)

• GAD is a persistent state of heightened anxiety characterized by excessive worrying and fear.
• Physical symptoms can include tremors, sweating, multiple somatic complaints, and exhaustion.
• GAD can be misdiagnosed as attention-deficit/hyperactivity disorder (ADHD) due to overlapping symptoms. A key difference is that children with GAD usually have more significant anxieties.

Social Phobia

• Social phobia involves persistent fear of humiliation, ridicule, or embarrassment in social situations.
• School refusal is often an initial sign, particularly in adolescents.
• Symptoms are often somatic in nature (e.g., "My stomach hurts").
• In severe cases, avoidance of social interaction and situations can be extreme.
• Behavioral therapy is crucial for treatment.

Separation Anxiety Disorder

• Separation anxiety disorder involves a persistent, intense, and inappropriate fear of separation from a primary attachment figure (usually the mother).
• Separation anxiety is normal in early childhood (ages 6-24 months) but resolves as children develop object permanence.
• In some cases, separation anxiety persists or returns later, becoming clinically significant.
• Often co-occurs with the mother's own anxiety symptoms, creating a reciprocal pattern.

Symptoms and Signs of Anxiety Disorders

• Separation anxiety frequently presents as school refusal.
• Anxiety can be compounded by parental anxiety symptoms.
• Children often exhibit patterns of repetitive requests for reassurance.
• Somatic complaints are frequent expressions of anxiety.

Obsessive-Compulsive Disorder (OCD)

• OCD is characterized by obsessions (recurring thoughts) and/or compulsions (repetitive behaviors).
• These symptoms significantly interfere with academic and social functioning.
• Most cases of OCD do not have a clear etiology, but PANDAS (pediatric autoimmune neuropsychiatric disorder associated with streptococcus) is a possible link in some cases.
• Early antibiotic treatment for PANDAS may be beneficial in preventing or reducing long-term effects.

Panic Disorder and Agoraphobia

• Panic disorder is characterized by recurrent and frequent panic attacks (at least once a week).
• Panic attacks are brief episodes (around 20 minutes) of intense physical or cognitive symptoms.
• Agoraphobia involves a persistent fear of being trapped or unable to escape from certain situations or places.
• Agoraphobia often co-occurs with panic disorder.
• Diagnosis necessitates ruling out medical causes for somatic symptoms.

Acute and Post Traumatic Stress Disorders (PTSD)

• Acute Stress Disorder (ASD) is characterized by a brief (approximately one month) period of intrusive experiences and anxiety following a traumatic event.
• Posttraumatic Stress Disorder (PTSD) involves longer-lasting (more than one month) intrusive recollections of a traumatic event.
• Not all children exposed to trauma develop ASD or PTSD. Vulnerability and temperament play a role.
• Trauma experienced by young children sometimes involves domestic violence.

Signs and Symptoms of Anxiety Disorders

• "Emotional numbing" describes symptoms including lack of interest, social withdrawal, and feeling numb.
• Hyperarousal is difficulty relaxing.
• Sleep disruption, including nightmares, can be common.
• Prognosis is influenced by trauma severity, associated injuries, and resilience in the child and family.

Prognosis and Treatment

• Prognosis for anxiety disorders depends on the severity, the availability of effective treatment, and the child's resilience.
• Treatment often involves behavioral therapy, focusing on exposure techniques to gradually desensitize the child to anxiety-provoking situations.
• Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly used if drug therapy is necessary.
• Benzodiazepines are sometimes utilized but are often less preferred due to potential negative effects.
• In some cases, a combination of behavioral and drug therapies is needed.